Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 013939 | CA |
N | 111NI0900X | Internist | 013939 | CA |
N | 111NN0400X | Neurology | 013939 | CA |
N | 111NN1001X | Nutrition | 013939 | CA |
NPI | 1215055801 |
---|---|
Provider Name | Dr. Thumper Bloomquist |
First Address | Burbank, CA 91506-1200 |
Second Address | Burbank, CA 91506-1256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |